Disclaimer: This article is for informational purposes only and does not constitute legal advice.
Detailed Answer
In New York, a statement of account (often called a patient or customer billing statement) itemizes charges, payments, adjustments, and balances. Insurance and government program payments appear under the Payments and Credits section. This section typically follows the list of services provided and their associated charges.
Key components where these payments appear:
- Insurance Payments: These are third-party payments from private carriers (e.g., Blue Cross Blue Shield). On the statement, they are labeled “Insurance Payment” or “Carrier Payment.” You will see the amount the insurer paid, the date of payment, and sometimes the claim or authorization number.
- Government Program Payments: These include Medicaid and Medicare reimbursements. On the statement, they often appear as “Medicaid Payment,” “Medicare Payment,” or “Public Program Payment.” State law requires clear labeling and itemization (see N.Y. Ins. Law § 3224-a for billing clarity: https://www.nysenate.gov/legislation/laws/INS/3224-A , and N.Y. Soc. Serv. Law § 367-a for Medicaid billing: https://www.nysenate.gov/legislation/laws/SOC/367-A ).
- Adjustments and Write-offs: After an insurer or program pays, the provider may adjust the patient’s balance. These appear as “Contractual Adjustment” or “Write-off” and reflect the difference between billed charges and the insurer’s allowed amount.
Example (hypothetical):
Charges:
Office visit (99213) $150.00
Payments and Credits:
Insurance Payment (BlueCross) -$100.00
Contractual Adjustment -$30.00
Patient Responsibility $20.00
Balance Due: $20.00
In this example, the insurance payment and the contractual adjustment both appear under payments and credits, reducing the total amount owed by the patient.
Helpful Hints
- Review the “Payments and Credits” section first to see all insurer or program payments.
- Look for labels like “Insurance Payment,” “Medicaid Payment,” or “Contractual Adjustment.”
- Verify payment dates and claim numbers next to each entry.
- If an entry seems unclear, request an itemized bill or an explanation of benefits (EOB) from your insurer.
- Keep all EOBs and statements for your records in case of disputes.